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Home My WebLink About6951-zFORM NO, 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Of(ce Southold, N. Y. Certificate Of Occupancy No. Z~9.~.~ ....... , Date ........... . .lv~.~....~? ........ , 19..~.. THIS CERTIFIES that the building located at ]o]~.thVf. e,~..La ............. S~t Map No~r.~s. ~ill~lock No ........... Lot No ....... ~.. ~.~.: ........... confo~ su~t~ti~y W ~e Application for Building Pemit heretofore ffl~ ~ ~ office dat~ ........... 0~ ~. ~.., 197~.. p~s~t to w~ch B~g Pe~t No: . 6951Z. dat~ ........... ~t.. [~..., 1~23., was issue, ~d co~o~ to ~ of ~e ~ ments of ~e app~cable pro~io~ of ~e law. ~e occup~ for wMch thi~ ce~ica~ h issued M . ~vate. one. f~ily. ~eZ~ ...................................... The certificate ~ hsu~ W . ~fF. ed [ CKp~ge. ....... ~e~ ...................... (owner, lessee or te~t) of ~e ~ores~d b~d~g. S~o~ Co~ty Dep~ent of He~th Approv~ . ~,B, .............................. U~ERWRITERS C~TIFICATE No.. ~ t~ ...................................... HOUSE ~ER .. 320 ........ S~t ...~ .~. ~ .!'0 .......................... 3~ ~ ~d ~ 11~ .... . ....... FOBM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 6951 Z Permission is hereby gronted to: Build an addition on exist.t~g dwel]..i~_.g at premises ~ocated at ..... ~h...V. iaw..D~. ............. ~r.~s..I~illa ........................................... ...... O~.en.~ ....................... pursuant to application dated .................. ;.;, ...... DO.t,....~.~ .......... , 19~.~...., and .opproved by the Building Inspector. Fee $$j.~ ............ Building nspector ~ FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-exlsting dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date ....'.?~......~..~.:~..~...Z.~/../. .............. New Building ................ Addition .....~; .......... Old or Pre-existing Building ................ Vacant Land .............. Location Of Property .~. ~'.~..'~. '/'¢'~ ~)..~.. ..,~...~."/.z¢,~.'~ ,~...~ - Owner Or Owners Of Property ,~r/~/~'~ ~' /~ r C_ ~. Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No. ,.~..~.:.~../...,.~.... Dote Of Permit /~.~...~.~.~..?.?. Applieant ..~f..~..~.7~' /J-/~,~/J.~. ~ Health ........ ........................... .... ................................... Und*rwritors Approv~l ....... ~...(~. ........................... ~l~nnin~ B~rd Approvo~ .... ~,.~: ......................... Request For Tempora~ Ce~i{icote ........................................ Final Certi{icote .......................................... Fee Submitted $ .................................... Construction on above described building and pej'mit meets all applicable codes and regulations. App,ieont ......... ...................................................... Sworn to before me this ................ day of ............................................ Notary Public .................................... County (stamp or seal) FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ........................................ , ~9. .. Permit No .................................... Disapproved a/c ........................................................... , ~ Application No. ~ zCS"/ APPLICATION FOR BUILDING PERMIT Date ~¢~ )'-~ ' -,~\ " 19_'[. INSTRUCTIONS o. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the BulldoZing Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue o Building Perm t to the opp cant Such ae~i shall be kept on the premises available for inspection throughout the work. ' ' e. No building shall be occupied or used in whole or in pa rt for any purpose whatever until a Certificate of Occupc~y shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in. buildings for necessary inspections. ................... (Signature of o~plicont, ....... ................. ........ ......... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .............................. .......................................................... : ............. : .................................................................. Name of owner of premises ........ ..~../....,f~/..(....~'..,~...~....~J ....... C/~...~..{~ ./.C.. ~ ............................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which proposal work_w be done Map No .......... Lot No Street and Number ............ ~...~/...¢....Ir~....~..!q~.,,~.O..G.L¥.¢..,~.DI.,,..//,~ ..................... .~...l'~.l..~,¢~ ................. Municipality State existing use and occupancy of premises and in:ended use and occupancy of proposed construction: 4~.LE.. ~.~eB-d.,.<;...Cz ......... ,"' a. Exisiting use and occupancy ....... ........................................... b. Intended use and occupancy ....... 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work .................................................... ~' (Description) 4. Estimated Cost ~.0~'-~) ~. ~ Fee /"~ (to be paid on filing this application) 5. If dwelling, number of dwelling units ....... L ................. Number of dwelling units on each floor ....Z ................... If garage, number of cars ........ ~ ............................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ...... .~'..~ ................ Rear ........ . .~.~...~ .............. Depth ..?...~. .......... Height ....... ~ ...........Number of Stories ........ /. ...................................................................................................... Dimensions of same structure with alterations or additions: Front ........ .~....~ .............. Rear ..... .~....?. ............... Depth ..... .'~..?.. .................... Height ....... ~ .............. Number of Stories ........../.. .................... 8. Dimensions of entire new construction: Front ....... ~......%m. ................... Rear ..... ~....~ ............ Depth ...... ..-~=....~.. ......... Height ....~...r. .......... Number of Stories ...... ../.. ........................................................................................................... 9. Size of lot: Front ............ .~...~..0 ................................ Rear .......... ~..~. .................... Depth ...... ~..~..~.. ............... 10. Date of Purchase ......... ./...~.¢...../'.. .......... ./...~.~../?. ......... Name of Former Owner ........ .~...~../Z.....~...~..~'../..~.. ................. 1 I. Zone or use district in which premises are situated .......... ..~..: .................................... ~ ......................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........ ./...~...~. ........................................ 13. Will lot be regraded .....~...~..~.¢./ --,--, --Will excess fill be removed from premises: ( ) Yes ( '~No 14. Name of Owner of premises ....~..../../~/./...../~..'~....f'.~...~.;/.~.~!C't~.. Address ..... ..~../~/...¢../.?..~.. Phone No ....................... Name of Architect .............................. ~. ............. i .............. Address ...................... ~.'~ ...................... ~ ..... Phone No. Name of Contractor ..... ./../.,4~7~....:..-....~.~../~..'//-/¢'//~ ......... Address ......~.../~'..C.e..C./.../...: ..... Phone No. ~.....~..Z.~.~.././.. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether exPting or proposed, and indicate oil set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. //OFt 7~ ~/~/e ~x /~,,~/~ , STATE OF N EW~/~ t S S COUNTY OF ...~~.~: ~.~, ,, ...f' · ......................... ~'~'..~..;../..~,~~~ ................ being duly sworn, deposes and says that he is the applicam (Name o~ indiv~dua~ signing contracf) above named. He is the ..................... ~ ~.~. ........ (Controctor, o~ont, corporate officer~ etc.) of sold owner or owners, ond is duly outhorized to perform or have performed the soid work ond to moke end file this ~pplic~tion; that oil statements contained in this oppHcotion ore true to the best of his knowledoe ond th~ tho work will be performed in tho monner set {orth in tBe opplicotion filed therewith. Sworn to bofore me this ;.;:;.. ...... ................. ........................................ / {Signature o{ oppticont) N0. ~;8~44963 SuffCtk Count~ ~ c0m~,~2~ ~el~ Met~h 38¢ I¢~~